Home Care and Medicare

FamilyElderly Care

  • Author David Crumrine
  • Published December 18, 2009
  • Word count 624

In-Home Care

Home health care can provide you with services in the comfort of your own home, these services are generally coordinated by a home health care agency.. Some services offered are skilled nursing care, physical and occupational therapy, speech-language pathology services, and medical social services as advised and ordered by your doctor. A home health aide can administer additional home health care services. These may include personal care, some housekeeping, meal preparation, and general health management. Home health care can help facilitate staying in the home for senior citizens and disabled individuals.

In order to determine the services you will need, health care professionals from a Medicare-certified home health care agency will work with you and your doctor in evaluating your needs and writing your care plan. Home health care agency staff will teach you and your caregivers to continue care such as wound care, therapy, and disease management. Reaching and maintaining your best physical, mental, and social well-being is the ultimate goal of in-home care.

If you are leaving a hospital or skilled nursing facility, the discharge planner can help you to set up in-home care. You can choose the specific agency you will use, but your choice may be limited by the services an agency offers, your insurance coverage, and the availability of the agency.

Services Covered

In order to be eligible for Medicare coverage, the health services used must be both reasonable and necessary in the treatment of an illness or injury. A home health care agency certified by Medicare may provide the following services:

Part-time or intermittent skilled nursing care by a registered or a licensed practical nurse

Personal and occupational therapy

Speech-language pathology services

If you are receiving skilled care or other therapy from the home health care agency, you may also receive part-time or intermittent home health aide services (including help with activities such as bathing, getting dressed, and using the bathroom) and medical social services (including counseling and help finding resources near you)

Certain medical supplies that are part of your care, including wound dressings

Durable medical equipment such as a walker


Medicare-approved home health services are free. Durable medical equipment such as wheelchairs, walkers, and oxygen equipment are available at a discounted price—20% of the Medicare-approved amount—and the Part B deductible applies.

Your Rights

If Medicare does not cover a certain service or supply, your home health care agency will give you a Home Health Advance Beneficiary Notice, which says that Medicare will not pay for the item or service in question. Be sure to read this notice carefully; if you sign the notice and Medicare does not cover the cost, you may have to pay for it in its entirety.

You will also receive a Notice of Medicare Non-Coverage before your Medicare-covered services come to a close. If you believe your services are ending too soon (before you have had the chance to recover), you may file for a fast appeal. Instructions detailing how to go about asking for a fast appeal can be found on your Notice of Medicare Non-Coverage. Your doctor may have information that will help your case. When you ask for a fast appeal, an independent reviewer will make the decision as to whether your services will continue.

You have the right to be involved in decisions regarding your treatment, the right to a fair process of appealing decisions regarding coverage and payment for services, and the right to privacy and confidentiality.

Avoiding Fraud

Although most home heath care agencies are honest and use proper billing information, fraud is not uncommon. Fraud may include home health visits ordered by your doctor but which were never actually carried out or bills for equipment or services that you never received.

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